Healthcare Provider Details

I. General information

NPI: 1134245889
Provider Name (Legal Business Name): EASTER SEALS FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE HILLMOOR DR STE 104
PORT ST LUCIE FL
34952-8057
US

IV. Provider business mailing address

2010 CROSBY WAY
WINTER PARK FL
32792-4119
US

V. Phone/Fax

Practice location:
  • Phone: 772-380-9972
  • Fax: 772-380-9976
Mailing address:
  • Phone: 407-629-7881
  • Fax: 407-629-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. RIKESHA BLAKE
Title or Position: CFO
Credential:
Phone: 407-629-7881